Your low PSA with a high Gleason score puts you in a very high-risk category, so it might be a good idea to start researching "high Gleason, low PSA" to see what new treatments have come online for that. Your triple-play HDR brachytherapy is a great start. Where are you located?
Here's a study of high Gleason, low PSA patients done by Dr. Paul Nguyen at Dana Farber in Boston. He's also an expert in HDR--the triple play approach. Find the top doctor who specializes in that at a cancer center near you.
Oh, you also asked about
quality of life issues. Everyone has suggested following a healthy lifestyle--this is so important in coping with the treatments. Eat as healthily as possible--way more plant based than you might be eating now. Get in long walks or short runs every day if possible to maintain mental and physical well being and bone strength. Start lifting weights now if you don't already.
ADT is fatiguing and has a depressive effect; exercise helps with the down sides. That said, my husband and I have taken multiple, major outdoor trips in the last five years though not early on when radiation was underway. (He didn't have HDR treatment but if he were dx'd now, he would go that route.) He routinely does 30-40 mile bike trips, jogs several times a week, lifts weights every day, and does household stuff as before. But he absolutely needs to nap a half hour every day, something he never needed before. He hates the brain fog that comes with the ADT (now Lupron, Zytiga, and Prednisone). Running and walking help with that as well.
We jointly research this awful disease. I go to all my husband's appointments. Keeping track of research, findings, test dates, drugs is our part-time job. Others can advise you on how to organize all this. I'll just add one tip for now: always, always bring extra copies of your most recent test results and drug regime with you to your doctor or PA even if its out of his/her lab. Just hand them over to the oncologist or PA to read on the spot at your appointments if they're scrolling for it on the computer. It saves time. (First appointment will be long. Thereafter, appointments are so short it's sometimes head spinning. We go to a major cancer center, and they process patients very quickly.) We input our appointment notes right into our respective computers as soon as we get home and check them before the next appointment. Come to your appointments with written questions. If a question pops up after you get home, make sure to ask it at the next appointment or, if it's urgent, contact the PA right away.
Good luck with all this. The disease takes away a lot, becomes consuming, but also is a wake-up call to devote more time than ever to the best parts of your current lives.
Husband 70 yrs pacemaker; Agent Orange 6-9/14: blood in urine; DRE suspicious bx 11/14: G 9 (4+5), PSA: 3.32 high Gleason, low PSA
11/14:Lupron 33 mos
6/15: 9 wks IMRT
4/18 0.98; 6/18: 3-4 bone mets; 7/18 3.29
8/18 9.0 Lupron re-started 11/18 7.0
Zytiga/Pred start 2/19 .7; 2/19: 4.0; 4/19 1.8; 6/19:1.2
Post Edited (spouse21) : 8/9/2019 5:39:00 AM (GMT-6)